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Face transplants


Dr. Cortez
It's been the theme of science fiction, a dream of plastic surgeons and of persons suffering from severe traumatic facial injury and, as of last fall, a reality. Doctors in France performed the first partial face transplant.

In a study recently published, Cleveland Clinic Foundation researchers used cadavers to determine the steps necessary for a full face transplant.

Cosmetic Surgery Times talked to plastic surgeons around the country about whether they expect to see face transplants taking place in the Untied States in the near future. We also talked about what the procedure would mean to patients in this country, what cosmetic applications it might have, and any ethical issues surgeons think the new techniques might engender.

Not what it seems

Dr. Alexander
Most of the doctors who spoke to On Track say they expect to see the procedures performed in the United States in the near future, although some say the surgery is not exactly as it is implied in the lay media.

In Montclair, N.J., Valerie J. Ablaza, M.D., says, "I expect that we will have face transplants here and I don't really see it as much of an ethical dilemma. If a person has a severe deformity and there's any chance of giving them a face back so they can get out into the world and live a halfway normal life, how could you keep someone from that?

"The worst injuries we see are the after-effects of a burn on the face. When those muscles are damaged and people can't animate any more, can't smile, can't open their mouths to eat, can't keep liquid from dribbling out, they can't kiss — the idea that we can help these things is incredible. It's one thing to have a disfigurement on the body where it's covered with clothing, but no one covers their face. People become socially ostracized because they look frightening, and it's hard to survive in the world with all the stares. People end up staying in and becoming shut-ins. We really can't do much — there's only so much skin grafts can do. There was nothing we could really do up until this —It may really replace all these lost things," Dr. Ablaza says.

Definition

Saul Asken, M.D., in Darien, Conn., says the term "face transplant" needs to be defined, and he's not convinced the most commonly envisioned procedure is the one that's going to be performed soon.

"The French procedure wasn't really a face transplant as it is pictured — going from the forehead all the way down to the chin. That didn't happen here. It was part of the face transplanted on to part of the face of an injured patient.

"A full face transplant is a different story altogether because it's denuding the skin on a cadaver and putting it on the face of patient who has suffered trauma, and we still have to deal with the vasculature and the nerve connections."

A practitioner for 46 years, Dr. Asken thinks that despite the recent success, he's not convinced the "whole" face transplant will be ready in the very near future.

"I definitely see this happening in the States where part of the face will be replaced by another part of a face to be transplanted to correct a defect that could not be corrected otherwise. The full-face transplant is another story. I don't think it's really possible at this time or even in the near future. In addition to the technical difficulties, there are ethical problems involved."


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